GENERAL SUBJECT(S): OVERVIEW: MENTAL HEALTH TRUST The following overview was taken in log note format. Tapes and handouts will be on file with the House Finance Committee through the 21st Legislative Session, contact 465-2156. After the 21st Legislative Session they will be available through the Legislative Library at 465- 3808. Time Meeting Convened: 1:50 P.M. Tape(s): HFC 00 - 23, Side 1 HFC 00 - 23, Side 2 PRESENT: X Representative G. Davis X Co-Chair Therriault X Representative Foster X Co-Chair Mulder X Representative Grussendorf X Vice Chair Bunde X Representative Moses X Representative Austerman Absent Representative Phillips X Representative J. Davies Absent Representative Williams ALSO PRESENT: REPRESENTATIVE TOM BRICE; JEFF JESSEE, EXECUTIVE DIRECTOR, ALASKA MENTAL HEALTH TRUST AUTHORITY, DEPARTMENT OF REVENUE; CAREN ROBINSON, CHAIR, MENTAL HEALTH TRUST AUTHORITY, DEPARTMENT OF REVENUE; NELSON PAGE, BUDGET CHAIR, MENTAL HEALTH TRUST AUTORITY, DEPARTMENT OF REVENUE. LOG SPEAKER DISCUSSION TAPE HFC 00 - 23 SIDE 1 000 CO-CHAIR MULDER Co-Chair Mulder convened the House Finance Committee meeting at 1:50 P.M. ALASKA MENTAL HEALTH TRUST AUTHORITY 173 CAREN ROBINSON, CHAIR, MENTAL HEALTH TRUST AUTHORITY Ms. Robinson distributed handouts from the Alaska Mental Health Trust Authority (AMHTA). [Copies on File]. She noted that the mission and vision of the Alaska Mental Health Trust Authority (AMHTA) was to administer the Mental Health Trust established in perpetuity. AMHTA has a fiduciary responsibility to its beneficiaries to enhance and protect the Trust and to provide leadership in advocacy, planning, implementation, and funding of a comprehensive integrated mental health program to improve the lives and circumstances of its beneficiaries. 210 MS. ROBINSON Listed the members of the Trustees Council: John Pugh, Phil Younker, Tom Hawkins, Nelson Page, John Malone, and Susan LaBelle and herself. 344 MS. ROBINSON Noted the customers of the Trust's Beneficiaries: ? People with mental illness; ? People with mental retardation & similar disabilities; ? Chronic alcoholics with psychosis; ? People with Alzheimer's disease & other dementia. 427 MS. ROBINSON Listed the boards that advise the Trust: ? Alaska Mental Health Board; ? Governor's Council on Disabilities and Special Education; ? Advisory Board on Alcoholism and Drug Abuse ? Alaska Commission on Aging. 454 NELSON PAGE, BUDGET CHAIR, MENTAL HEALTH TRUST AUTHORITY, DEPARTMENT OF REVENUE Addressed the programs and the responsibilities of the AMHTA. ? Manage the land and cash assets of the Trust in perpetuity; ? Provide leadership & advocacy for beneficiaries; ? Recommend the State's budget for the Comprehensive Integrated Mental Health Program; ? Spend Trust income to improve lives and conditions of beneficiaries. Mr. Nelson spoke to the Trust Fund Assumptions and the Trust Fund Actual received. 667 VICE CHAIR BUNDE Pointed out that the "pay out" was less than intended. 746 MR. PAGE Replied that amount indicates the success of the program. He acknowledged that the Trust was ahead of the number indicated. 791 CO-CHAIR MULDER Asked if the $40 million was real estate assets. 808 MR. PAGE Replied that they are all liquid assets. 820 MR. PAGE Spoke to the liabilities. He noted that in FY01, there is money that can not be considered as an asset. 850 JEFF JESSEE, EXECUTIVE DIRECTOR, MENTAL HEALTH TRUST AUTHORITY, DEPARTMENT OF REVENUE Explained that when funds are obligated through the mental health bill, that portfolio then will be separated into a separate account. 885 REPRESENTATIVE J. DAVIES Noted that these funds were set aside to cover the liabilities. 903 MR. PAGE Explained that there are funds which are generated as the land assets. The total this year of that amount is about $17.5 million dollars. 941 MR. PAGE Spoke to the increase of revenues that have been generated by timber sales and land that has been sold. Additionally, AMHTA has tried to be a good partner in land swapping. 1033 REPRESENTATIVE J. DAVIES Questioned the land sales philosophy. 1045 MR. PAGE Explained that the Trust is not trying to dispose of land assets. At this point they are trying to maximize the revenues into perpetuity. 1078 MS. ROBINSON Added, the staff has developed agreements with the various communities so as to work in agreement rather than conflict with one another. 1138 MR. JESSEE Reminded members that the Trust was in the mental health business. He emphasized that there is a difference between the cost of doing business and creating mental health communities. He noted that AMHTA is trying to be sensitive to generating revenue and still sensitive to community needs. 1222 REPRESENTATIVE GRUSSENDORF Inquired if a situation has arisen where the Trust had advocated for a land exchange. 1241 MR. JESSEE Acknowledged the situation in Juneau with the sub-port facility. The Trust approached CBJ with the proposed land exchange so as to be able to develop the property. The intent is to always create a win/win situation. 1325 MS. ROBINSON Added, if the initial proposal does not work, then other alternatives are explored. 1385 MR. PAGE Expanded on that concern. He spoke to a "memorandum of understanding" with each community before development takes place. 1439 MS. ROBINSON Addressed the results that the Board is looking for: ? Are Trust beneficiaries healthy? ? Are they safe? ? Are they economically secure? ? Are they productively engaged or in school? and ? Are they living with dignity, as valued members of their communities? 1504 MS. ROBINSON Addressed the comprehensive plan and how that was determined. She indicated that there had been a statewide survey to identify the various beneficiary groups. 1561 MS. ROBINSON Noted that the next volume would be available in January 2002. 1589 MS. ROBINSON Provided the evaluation criteria: ? Did they do what they agreed to do? ? Did they do it when they said it would get done? ? What was the effect on the people they served? ? Did the program/service cost less than "doing nothing"? and ? If the product isn't what we hoped for, what can we learn? 1650 MS. ROBINSON Noted that each agency is required to provide a status report twice a year or more. It is obvious that there are housing needs for people coming out of this program. 1700 REPRESENTATIVE GRUSSENDORF Asked what would happen if no result happen. 1712 MR. JESSEE Replied that none of these situations are free. Rather than spending all the resources of the Trust, they are done only after undertaking a cost benefit analysis. 1753 REPRESENTATIVE J. DAVIES Inquired if it would cost more to do nothing. 1763 MR. JESSEE Replied that in many cases it does and particularly in the criminalization of those people who are mentally ill. 1788 REPRESENTATIVE J. DAVIES agreed that this would be a financial and efficiency measure. 1809 REPRESENTATIVE GRUSSENDORF Pointed out that this is costing less to both the Trust and the State. 1821 MS. ROBINSON Commented on some of the programs that have been funded. 1837 MS. ROBINSON Fairbanks Chronic Inebriate Program - She listed what they did: ? Expanded Community Service Patrol; ? New transfer station; and ? Domiciliary treatment for public inebriates. They did that in the first year which resulted in about 984 fewer calls to Police Department about public inebriates. 1923 VICE CHAIR BUNDE Asked the investment in the program. 1931 MS. ROBINSON Provided those figures which would be transferred to Mental Health in 2002. To date, the cost has been $200 thousand dollars. 1959 MR. JESSEE In response to Vice Chair Bunde, Mr. Jessee noted that the number of fewer calls could be provided but not the number of total calls. 2000 MS. ROBINSON Emphasized that the number of calls was substantially lower. The vast majority of the fewer calls were directly related to that program. 2055 MR. PAGE Addressed the next project which was the Provider Capacity Building - 1998/1999 * Funded by Trust, UAA & federal government; ? UAA taught classes, developed on-line & video training; ? Trust paid $100 thousand dollars for scholarships for grantsmanship classes; ? 73 received scholarships. 2157 MR. JESSEE Stated that the type of projects that were awarded were mental health related. The intent was to help develop a skill. 2180 REPRESENTATIVE J. DAVIES Asked if any of the grants displaced money from existing programs. 2193 MR. JESSEE Replied that he did not know. 2203 MR. PAGE Added that within each program, the Trust has built in some criteria to determine the success of the program. He noted that each program funded would have good accomplished by it. 2231 MS. ROBINSON Continued listing the projects: Trauma Victim Study: Providence Hospital ? In 9 months of 1999, 156 people admitted to the emergency room, injured while under the influence; ? 5 died and 1 remained in a coma; ? 120 received substance abuse consultations; ? 106 received motivational interventions; ? 70 complied with treatment recommendations within 1 month. 2298 MR. JESSEE Noted that the hospital created the criteria regarding the influence and the injury. TAPE HFC 00 - 23 SIDE 2 000 MR. JESSEE Stated that it is important to establish what the costs actually are mental health issues impact that. 039 MR. PAGE Spoke to the Jail Alternative Services (JAS): ? In 1998, Mental Health Court saw 138 people with mental illness, developmental disabilities or brain injury; ? 111 also had substance abuse problems; ? 36 volunteered for intensive case management through JAS; ? 59% decrease in API admissions for JAS participants compared to; ? 60% increase in API admissions for non-JAS participants. 213 CO-CHAIR MULDER Asked the cost differential for the type of treatment for the JAS versus non-JAS. 242 MR. JESSEE Stated that he could not give those numbers but he knew it was significantly less than API charges. 275 MS. ROBINSON Offered to provide that information. 290 MR. PAGE Noted that AMHT had provided money FY00 and FY01. 340 MR. JESSEE Explained the eligibility criteria for those selected. He added that part of the financial balancing is the per year costs and spoke to breaking the cycles to place these folks in a more stable situation. 414 MR. JESSEE Added that the Court System and Justice System costs must be considered. 441 VICE CHAIR BUNDE Questioned the numbers being used to compare. 488 REPRESENTATIVE J. DAVIES Asked who the mental health board was. 503 MR. JESSEE Replied that it consisted of district court judges, defensive attorneys, and lawyers who identify these people and try to meet their needs before they become serious. The JAS alternative services have added the benefit of Mental Health liaison to help with these problems. 614 REPRESENTATIVE J. DAVIES Asked what happened to the 102 persons listed previously. 648 MR. JESSEE They were given incentive to follow through on some type of treatment. 692 CO-CHAIR MULDER Stated that this an outgrowth of the Criminal Justice System. He pointed out that 37% of those in the current jail system have some sort of mental illness. He pointed out that 102 preferred to go to jail than go into the treatment system. 760 MS. ROBINSON Noted that the Trust is trying to determine other alternatives to going to jail. 784 VICE CHAIR BUNDE Stated that perhaps they prefer jail because of a warm place to live. 804 CO-CHAIR THERRIAULT Referenced Page 5, the modest increase over the previous year. 824 MR. JESSEE Replied that in FY99, there was a lucrative timber sale; and over + million of that was from that sale. 858 MS. ROBINSON Spoke to the Women's Residential Substance Abuse Treatment in Corrections. She added that now there is no waiting list to receive treatment. The Trust's money has leveraged 80% federal funded dollars through the Department of Corrections. 940 MS. ROBINSON Spoke briefly to the Healthy Families component. She indicated that program is very successful. 970 CO-CHAIR THERRIAULT Asked if John Hopkins had developed the criteria for that program. 995 MS. ROBINSON Did not know, but she did know that it was being set. She offered to provide that info to the Committee. 1019 MR. PAGE Spoke to the Alaska Psychiatric Institute (API). He commented on what happened in with that hospital: ? What the Trust and DHSS said we would do was to address the API replacement problem. ? What we did: Community implementation plan; due diligence review of property; established removal costs for the old building; confirmed need for hospitals 54-72 beds. ? What we are doing now: Completing a coordinated package, buy a new building, remove old building, pay for community services before federal rate changes cost the State millions more. 1210 MR. JESSEE Noted that the Department of Health and Social Services has been very helpful in improving the quality of care in that facility. 1240 MR. PAGE Commented that the main concern now is the aging old building. 1255 MS. ROBINSON Spoke to System Improvements ? Trust paid for several system reviews such as HCB Waiver study, guardianship review, managed care study and economic development review; and ? Results with no general fund costs such as waiver system changes, OPA and DSS re-structuring, Mental Health Medicaid regulation changes, $2.1 million federal employment demonstration project. 1381 MR. PAGE Spoke to the best use of resources. 1427 MR. PAGE Addressed the responsible oversight of the Trust. ? The Young Adult Transition Program FY98-99; and ? The Children's care coordination pilot project for FY97-99 These programs were not functioning to the expected level. The funding was cut for both those programs. He urged Committee members to understand that the Trust is concerned about State funds. 1575 MS. ROBINSON Spoke to the Trust Priorities: ? Assisted living; ? API; ? Decriminalizing the mentally ill; ? Emergency behavioral health care; ? Medicaid and basic support. 1666 MS. ROBINSON Commented on the "Future" The Trust is: ? Two-year comprehensive integrated mental health plan; ? Two-year budget cycle; ? Fewer projects with longer terms. 1717 REPRESENTATIVE J. DAVIES Asked how the community-based programs were doing. 1728 MR. JESSEE Replied that generally the progress is good, however, there are difficulties. The projects need to be co-located in a facility. The likely vendor should be Providence Hospital but they have no room. Another issue is that one of the main components of the system is having a 24-hour service center. There is not the interest in Anchorage because there is competition in the health care industry in that city. He suggested that the State could undertake that through the procurement process. There are other facilities that could be built for the contract. The Department is sorting that out at this time. 1835 MS. ROBINSON Added that there has been good work done. The Commissioner has hired Lloyd Jones to help with this work. It is not there yet, but it is in motion. 1865 REPRESENTATIVE GRUSSENDORF Asked a question providing a hypothetical situation in a potentially dangerous situation. 1912 MR. JESSEE explained that there are people who develop mental disabilities and operate from a more childish peer group. There currently is a residential program in Anchorage for that group living situation and that model does have a 24-hour staff. It is expensive to serve those people. Along with that is an educational treatment providing structure for appropriate feelings. 1989 MS. ROBINSON Added that the Trust has made funding available to assess brain injury studies. The Trust is working on that consideration at this time. 2024 MS. ROBINSON Applauded all the various Boards that contribute to the work of the Trust and the Department of Corrections and the Department of Health and Social Services. 2057 MS. ROBINSON Reiterated that there are amazing consumer groups throughout the State that are watching the Trust and working with it. 2075 CO-CHAIR MULDER Thanked the Trust for determining the missions and measures and then providing that information to the Committee. He stated that AMTA has a well-defined program. 2117 VICE CHAIR BUNDE ADJOURNMENT The meeting adjourned at 3:20 P.M. HOUSE FINANCE COMMITTEE LOG NOTES February 2, 2000 H.F.C. 9 2/02/00